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Demo frustrates in Jurisdiction B

WASHINGTON – Sending in each power wheelchair prior authorization request to the DME MAC multiple times has added more than a month of wait time for patients, says provider Lu Ann Davis.

It’s especially exasperating because the paperwork has everything it needs, she says.

“I don’t know if the reviewers are not looking the stuff over completely or what, but it’s been very, very frustrating for us and our clients,” said Davis, co-owner of Springfield, Ill.-based Personal Mobility. “The process has not been easy.”

While most providers report better results under CMS’s seven-state power mobility demonstration project, which began Sept. 1, 2012, many providers in Jurisdiction B, like Davis, are reporting problems.

Davis has submitted more than 20 requests to the DME MAC and none have gone smoothly. All of the denials have been for technical issues, such as date stamps and doctor signatures.

“I have not had one that’s been anything to do with medical necessity,” said Davis. “It’s all paperwork.”

If there’s a silver lining, it’s that providers seem to be on the same page when it comes to telling referral sources they need top-notch documentation to help combat these difficulties, says Derek Miller.

“Referral sources aren’t saying ‘We don’t have to do this for other providers,’” said Miller, vice president of rehab for Indianapolis-based Home Health Depot. “These standards are being reinforced by our competition.”

Providers say they’re in favor of requiring prior authorizations because CMS responses spell out the documentation doctors need to provide, and approved prior authorizations offer some assurance providers will get paid.

“It takes the pressure off the dealer and puts some of it back on the doctor,” said Roger Lichty, owner of Rockford, Ill.-based Mobility Connection.